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Randomized Controlled Trial
. 2023 Aug;76(4):317-325.
doi: 10.4097/kja.22188. Epub 2023 Mar 14.

Modified pectoral nerve block versus bi-level erector spinae plane block for postoperative analgesia after radical mastectomy surgery: a prospective, randomized, controlled trial

Sevim Cesur  1 , Can Aksu  1 , Sertaç Ata Güler  2 , Alparslan Kuş  1
Affiliations
Randomized Controlled Trial

Modified pectoral nerve block versus bi-level erector spinae plane block for postoperative analgesia after radical mastectomy surgery: a prospective, randomized, controlled trial

Sevim Cesur et al. Korean J Anesthesiol. 2023 Aug.

Abstract

Background: Regional anesthesia techniques constitute an important part of successful analgesia strategies in the perioperative care of patients undergoing breast surgery. The advent of ultrasound-guided regional anesthesia has led to the development of fascial plane blocks. The large array of blocks available for postoperative analgesia in breast surgery has increased the accessibility of regional anesthesia but has also created a dilemma of choice. This study compared the analgesic efficacy of the ultrasound-guided modified pectoral nerve (PECS) block and erector spinae plane block (ESPB) in patients undergoing radical mastectomy.

Methods: Seventy women were enrolled in this prospective, double-blind, randomized control trial. After exclusion, 67 female patients who underwent radical mastectomy were finally analyzed. Ultrasound-guided PECS blocks and ESPBs were performed with 30 ml 0.25% bupivacaine. Postoperative morphine and pain scores were compared between the groups.

Results: Postoperative total morphine consumption in the first 24 h was significantly higher in the PECS group (P < 0.001). The ESPB group exhibited significantly reduced morphine consumption at all postoperative time points. Numeric rating scale scores were lower in the ESPB group at 6, 12, and 24 h postoperatively at rest and when coughing.

Conclusions: Ultrasound-guided bi-level ESPBs provided better postoperative analgesia than PECS blocks after radical mastectomy surgery.

Keywords: Analgesia; Breast neoplasms; Diagnostic imaging; Local anesthetics; Nerve block; Postoperative pain..

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Conflict of interest statement

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
CONSORT flow diagram of the study. PECS: pectoral nerve block, ESPB: erector spinae plane block.
Fig. 2.
Fig. 2.
Ultrasound image of the modified pectoral nerve block and erector spinae plane block. (A) Ultrasound image of the modified pectoral nerve block. (B) Ultrasound image of the erector spinae plane block. PM: pectoralis major muscle, Pm: pectoralis minor muscle, LA: local anesthetic, SA: serratus anterior muscle, R4: fourth rib, TM: trapezius muscle, RM: rhomboid muscle, ESM: erector spinae muscle, TP: transverse process, T4: 4th transverse process.
Fig. 3.
Fig. 3.
Bar graph of morphine consumption according to time and group. PECS: modified pectoral nerve block, ESPB: erector spinae plane block. *Statistically significant difference between the PECS and ESPB groups. Values are presented as median (bars) with percentiles 25th–75th (error bars).
See this image and copyright information in PMC

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